Background Amyloid in fine needle aspirates tends to be overlooked due to its rarity. It may appear at virtually any site and can be identified by special stains. Case In a case of amyloidosis of the liver, where fine needle aspiration cytology was instrumental in making the pri- mary diagnosis. Smears revealed nor- mal hepatocytes and chronic inflam- matory cells. Amorphous material (amyloid) was extensively present be- tween compressed hepatocytic clusters. It stained pale green in Papanicolaou- stained preparations and reddish pur- ple with Giemsa stain. This material was initially thought to be hyalinized granulomas. However, it was later confirmed to be amyloid by using Congo Red stain. Conclusion Whenever amorphous material is present in smears, a high index of suspi- cion for amyloid needs to be maintained. (Acta Cytol 2006;50:574–576) Keywords: amyloidosis; aspiration biopsy, fine-needle; liver. A myloidosis is the generic term used for a group of diseases resulting from the extracellular accumu- lation, in single or multiple organs, if an insoluble fibrillary protein called amyloid. Amyloid may be deposited focally or diffusely and can affect any tissue. Hepatic infiltration with amyloid occurs in nearly 70% of patients with either primary or secondary amyloido- sis, yet clinically dominant liver amyloid is uncommon. 1 Fine needle aspiration cytology (FNAC) has been employed suc- cessfully in detecting the presence of amyloid in various organs, such as thyroid, 2 spleen, 3 skin 4 and lung. 5 Nevertheless, amyloid is a rare finding in fine needle aspi- rates and tends to be overlooked. 6 We report here a case of hepatic amyloidosis in which fine needle aspiration cytology was instrumental in making the initial diagnosis. Case Report A 55-year-old woman presented with a lump in the right hypochon- drium and fever of 2 months’ duration. She was icteric, and abdom- inal examination revealed grade 2 hepatomegaly. Abdominal ultra- sound revealed diffuse enlargement of the liver. FNAC of the liver was performed under ultrasonographic guid- ance with a 24-gauge needle and 10-mL syringe. Ethanol-fixed and air-dried smears were prepared. The alcohol-fixed smears were stained with Papanicolaou stain and the air-dried smears with Giemsa stain. The aspirate of the liver contained hepatocytes, many showing clearing of nuclei, and chronic inflammatory cells in the back- ground. In some areas there were large deposits of amorphous ma- terial between the hepatocytes. This material had compressed the adjacent endothelial cells and hepatocytes into flattened cells with ill-defined, pale cytoplasm and elongated nuclei. The nuclear chro- matin of these cells was finely granular, and the overall impression was of flattened epithelioid cell groups in hyalinized granulomas FNAC has potential as a cost-effective, minimally invasive ap- proach in the diagnosis of amyloidosis of the liver. Cytodiagnosis of Hepatic Amyloidosis by Fine Needle Aspiration Cytology A Case Report Nitin Gangane, M.D., D.N.B., Anshu, M.D., Vitaladevuni B. Shivkumar, M.D., and Satish Sharma, M.D. From the Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha (Maharashtra), India. Dr. Gangane is Professor and Head. Drs. Anshu and Shivkumar are Readers. Dr. Sharma is Professor. Address correspondence to: Nitin Gangane, M.D., D.N.B., Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram 442102, Ward- ha (Maharashtra), India (nitingangane@rediffmail.com). Financial Disclosure: The authors have no connection to any companies or products mentioned in this article. Received for publication February 10, 2005. Accepted for publication August 29, 2005. Case Reports ACTA CYTOLOGICA 0001-5547/06/5005-0574/$19.00/0 © The International Academy of Cytology 574 DO NOT DUPLICATE © Copyrighted Material